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PBS NewsHour poll solicits views on the future of health care

ALEXANDRIA,Va. – Patients, physicians and the public are invited to participate in a national poll about primary health care in the United States in 2025, what it might look like and what is the best-case scenario. The one-week poll will be posted on the PBS NewsHour website through Feb 7.

Participants are asked to evaluate four possible scenarios presented by futurists affiliated with the nonprofit think tank Institute for Alternative Futures. The scenarios are based on findings in “Primary Care 2025: A Scenario Exploration,” a report recently released by the institute.

Working with more than 50 national health-care leaders, the institute considered the nation’s economic challenges, political polarization, and opportunities afforded by technological advances and new delivery systems when developing the scenarios.

The four options give readers a glimpse of how Americans could select, pay for and receive primary care, and how patient-doctor relationships may change, says Clem Bezold, Institute for Alternative Futures chairman and senior futurist.

To illustrate how patients could be affected under the various scenarios, the NewsHour has videotaped four short vignettes about a hypothetical patient, a single, employed woman named Mary, who has diabetes.

The vignettes are posted on the NewsHour website. Visitors are asked to view the brief video discussion of each scenario and vote for the most likely and the most preferable.

The vignettes are presented by Bezold; Eric Meade, vice president and senior futurist at the institute; Jonathan Peck, president and senior futurist; and Barbara Krimgold, a member of the institute’s board of directors and senior project director for the Center for Advancing Health.

“It’s important that people realize primary care may be different in the future, and we will have to make choices. The scenarios identify some of the possibilities,” Bezold says.

It is hoped the poll will spark a national conversation and provide valuable information about the public’s views on the future of health care. Poll results also will be compared to the conclusions of the leadership group that used the scenarios in a national workshop held September, Bezold says.

The scenarios

No. 1 “Many Needs, Many Models”

This scenario is a natural extension of health care as many Americans know it. The scenario forecasts a shortage of primary-care physicians, increased emphasis on disease prevention, growth in electronic medical recordkeeping, a shift from employee-based insurance to health insurance exchanges, and growing disparities in access to and quality of primary care based on income and where people live.

No. 2 “Lost Decade, Lost Health”

This scenario forecasts a shortage of primary-care physicians, declining income for practicing physicians, and more uninsured patients, some of whom resort to black market care and unreliable online advice. Patients with good insurance have access to great care enhanced by advanced technology.

No. 3 “Primary Care that Works for All”

This scenario assumes nearly universal health care coverage, with 85 percent of patients using integrated systems staffed by collaborative teams of health-care providers, including physician assistants, nurse practitioners and health coaches who work closely with patients. Seeking to provide better care at lower cost while improving the health of the population they serve, primary-care teams join with community partners to address factors that affect a community’s health, including employment, educational attainment, housing, transportation, and access to fruits and vegetables.

No. 4 “I Am My Own Medical Home”

Under this scenario, four of 10 patients opt for consumer-directed health plans, which include catastrophic insurance with high deductibles. For the most part, savvy consumers use advanced technologies, including noninvasive biomonitors and wellness and disease management apps, to stay healthy. Large vendors offer free avatar-based health coaching to consumers who purchase other integrated health products and services. Consumers shop for the best doctor and buy on the basis of high quality and low price.

The Institute for Alternative Futures’ “Primary Care 2025: A Scenario Exploration” is supported by a grant from The Kresge Foundation as part of the foundation’s mission to improve the delivery and financing of health care in the United States.

In addition to the full report, the project’s website includes instructions for using the scenarios in workshops. Kresge also supports the NewsHour.